Thursday, September 8, 2011

Wrapping Things Up Part III: What I'm thankful for

What I’m thankful for (or who in my case)
The biggest gift I got in Botswana was the chance to work with an amazing group of people. This experience would have been nothing without them. I was blown away with their generosity in teaching me and I am hell-bent on “paying it forward” at every available opportunity. 

Dr. Kovarik: she is the principle investigator of the vulvar cancer study and she is the one who sent my to Botswana. First of all, I am in awe of her: her accomplishments are staggering especially given how young she is. More than that, I am impressed by her can-do attitude: she is involved with so many projects and . I was introduced to her by a dermatologist I was shadowing and within our first meeting she set me up with this opportunity and even tried to help me find another project for last spring.
Her trust in me was really humbling and I was determined not to let her down. She was so supportive of my throughout this whole process: responding thoughtfully to my emails and encouraging me to pick up other projects. Also, I really appreciate that Dr. Kovarik was willing to let me shape my own experience. Not only that, she really listened to my input when I raised concerns or offered suggestions on how to better the study. I can't believe how lucky I was to have had this opportunity and I really hope I can work with her in the future.

Jennifer (aka Jenny G): although Jenny was only around for a week, I feel like I found a lifelong friend (yes, corny). Jenny gave me permission to unleash my inner derm nerd. She would answer streams of questions, let me do board exam practice questions with her and talk to me about how I can get more involved with derm at Penn. I can’t think of a more patient, non-pretentious and thoughtful teacher than Jenny. I am actually writing this post on a bus to NYC and one of the reasons I’m going (besides my birthday on Monday!) is to see Jenny who just took her first job there! 
Aileen: Aileen is a fourth year at Penn and I've adopted her as my "derm big sister." We met before Bots and clicked right away. She offered me advice on everything from when to do my rotation to which necklace to wear and she was even nice enough to let me help her with a mobile learning study. I'm psyched that she's in Philly another year.

I've already written about Kari and Dougie so I'll keep in brief but no list of mentors would be complete without these two:

Kari (aka the Wanat aka Armageddon): Kari Wanat may be the nicest person ever but trust me, she is no pushover. Her arrival was a burst of enthusiasm and to say that she is hardworking and intelligent is an understatement. And her unique combo of disarming smile + midwestern accent + determination is amazingly effective at getting things done!

Doug (aka Dougie Fresh): my partner in crime for 4 weeks and one of the funniest people I have ever met. He was endlessly patient with me and my insane amount of questions and a great doctor.

As you can see, I was really blessed to have hung out with  such an awesome crew. They shaped my experience in such a major way. I am but a lowly med student peon so I can't express enough gratitude for how much they included me and shared their knowledge and experience. So thanks to team derm for making this such an unforgettable summer! 

P. S. Thanks so much to Jessica Mikulski and Penn for spotlighting my blog on the Penn Medicine website Renee Chenault-Fattah for interviewing me on NBC Healthwatch before I left/featuring my blog on their facebook page, and Lisa Katz for linking my blog on the PSOM alumni page. Lastly, thanks to my grandmother for reading this blog because despite all the above publicity, I'm pretty sure she's the only one to actually read most of it (confirmed by the fact that my own mother admitted to being a periodic you mom!).

P.P.S If you reallllllly miss my killer puns and witty prose (I'm looking at you Nana)....I'm blogging as a part of the Perelman School of Medicine blog. No meerkats or lions (yet....) but I've already posted a picture of me waist deep in the dirty water of the Schuylkill river so that might be worth a gander just to laugh at my poor judgment.

Wrapping Things Up Part II: What I will take away from this experience

I filled 3 of these books with crazy bits of derm trivia!
1. A love of dermatology: I learned so much in a very literal sense: while my Setswana didn’t improve as much as I might have liked, I learned so much of the language of dermatology. And I loved it. I can't wait to get more involved now that I'm back at school. I've been finding cardio tough so I've started a game with Kari where I email her the disease we are learning about and she replies with the skin problems that go along with that disease. Luckily Jen donated a large pile of derm books so I'll have plenty of opportunity to keep learning. I know, I know...I'm a huge nerd. 

2. The knowledge that I want to make international work a part of my career. I felt so at home in Bots and I felt the same way in Malawi. I can't wait to find out how my career evolves to include this passion. 

How could you not want to work somewhere this amazing?
3. Most importantly however, I learned, or rather got re-acquainted with, my own competence. Medical school isn’t kind to everyone and although I’ve been very successful grades-wise, I’ve been struggling with my own version of the imposter syndrome common to medical students: I keep waiting for someone to “find out” that I am not as smart or as hardworking as my classmates. And frankly, in some ways, that is true. I am not great at sustained periods of memorization and that is the key to med school success in many ways. I think that last year, I always felt sort of bad because I wasn’t spending as much time with the material as my classmates. As we learned in psychiatry, situations like that can set you up to create a very negative self-evaluation. Fears about not living up to my potential made it hard to be proud even though I did really well in terms of external markers like grades.

Botswana was the antidote to that feeling: I wanted to go to work...wanted to stay longer at work... wanted to find projects that would give me more work and I did that work well enough that people started giving me more and more responsibility. Positive feedback is always great but feeling proud of myself was the best feeling in the world. So basically, I had the opportunity to re-ignite my passion for medicine while meeting and working with some truly amazing people. I will echo my first I lucky or what?

Wrapping things up: Part I- Botswana Survival Guide

Ever since I’ve been back, I’ve been trying to synthesize my Botswana experience and decode what it meant to me, what I learned and how I wanted to grow as a result of my time there. Sheesh. Talk about biting off more than you can chew.   This sort of experience, unsurprisingly, doesn’t take kindly to attempts to categorize, contain or label it in a consise way but as per usual, I’m going to try my best. Also per usual, I was feeling verbose and thus am going to split up my thoughts into 3 posts.

Patience, perseverance and the delicate combo thereof: my experience in Malawi gave me a leg up on this one: it can be so incredibly frustrating to work in a developing country. Most people think that is because of a lack of resources: “it must be hard to want to treat someone with a medicine or procedure that you don’t have.” I suppose that is true, but I think that most people who do this kind of work are prepared to make the best of what is available. What people are less prepared for is dealing with what people like to term “cultural differences” or “inefficiencies” (I find these somewhat euphemistic).

Hard to get frustrated when you get to see babies in clinic
I told Kari of the metaphor I like to use for my interactions at the hospital: one of the those dolls that you punch but they keep springing back up. Whenever I wanted to accomplish something (fix a microscope, check on a patient, get a photocopy, install software etc), I would get rebuffed or redirected almost instantly: “why don’t you talk to Mr. So and So, come back later, we don’t do that here etc etc.” I'd call it getting PMH-ed. The trick was not to get annoyed by that or respond by being pushy. I would simply write down the information I needed and say “What is Mr. So and So’s phone number? I will be here tomorrow at 8:00 and I hope to find him here.” Do this enough and people realize that you are serious and they will help you. Remarkably effective actually. 

When all else fails, use junk food: It is important to remember that you are a guest. While you should never compromise when it comes to an issue of patient care, it’s still important to be polite and respectful. Bringing offerings of food never hurts. 
Behold the transformative power of cake! Saying thank you to all my lab buddies.
Let go of your elitism: it would be really easy to leave Botswana disgusted by way some things are handled. And it’s true- there is no excuse for letting patient care fall by the wayside. It was hard to stomach sometimes: I met doctors who seemed not to care about their patients, nurses who would routinely use facebook during clinic etc etc. One time I tried to bring a very ill patient into the dermatology clinic room but the nurses insisted I find somewhere else because they wanted to go home. Patients weren’t generally handled with deference and I saw some things that really horrified me. It would be easy to emerge from this experience smug in the knowledge that many of these issue would be better handled in the US….BUT let’s remember that the US fails on patient care in other ways: we order unnecessary tests, practice defensive medicine, don’t spend enough time with our patients and we are participating in a healthcare system that is unsustainable. So coming from a place of judgment not only limits what you can learn from a place, it also is sort of hypocritical.

Going above and beyond: a nurse at Kanye
Try not to generalize: Many of the physicians I met did not take initiative at all, many would try to shunt responsibility whenever possible. In some ways, this colored my experience at the start of my trip especially because the nurses I worked with in Malawi were dedicated almost to a fault. However, for every lazy lab tech, sullen nurse and irresponsible doctor- there were 3 other people who would go above and beyond for patients, their colleagues etc. I was blown away by the microbiology lab worker who let us look at crfptococcuc under the microscope just so we could learn or Bonnie, the nurse who looked up a patient’s phone number (I still have no idea how she did that) so we could ask if they got treatment for a DVT.

Most the door to your room on safari: or a monkey will come in and steal your coffee...duh!

Things that make me chuckle

"Beauty Clinic: for all your Psychiatric Treatments"

"Pubic Servants are expected to be Polite and Efficient"

Leaving Botswana (aka FOMO central)

Last day: With Dr. Pina and Dr. Motsepe (both dematologists)
I really didn't want to leave Botswana. Like REALLY didn't want to leave. To the point where Kari and I were scheming up ways that I could change my plane ticket (turns out if I didn't fly home on the 10th the next available flight was on the 31st so that was a no go).

Byebye Bots :(
First of all, I had such an incredible summer. Second of all I was having a major case of FOMO, which is "Fear Of Missing Out." How could I leave when my flatmates were planning a camping trip? And we'd just gotten started hearing our results for pathology- how could I leave when I didn't know if firm flesh colored papules were trichilemmomas or angiofibromas?

But alas, resistance was futile and I had to say my goodbyes. My flight was in the evening but I insisted on a full day at clinic/lab. We had a celebration with the path lab people (complete with a cake we brought to say thank you for putting up with us), hugged all the nurses, checked that the VisualDx was running OK and promised everyone I'd come back as soon as possible.

My flight was uneventful and I was home in no time (and by no time I mean a full 26 hours later)  Le sigh. I miss Botswana already.

The airport in Gaborone is so nice! Crazy to think that they have this nice airport but not enough beds in the hospital.


Loving that Boston pride! This is Koziba, the 2nd oldest daughter of Hilda (who is the housekeeper in the flat I stay in). She is 18, a bundle of energy and she has an adorable 1 yr old named Prince. The shirt was a gift from Ryan who is from Boston and now lives and works in Gabs (he works for Dr. Kovarik actually). Just thought I'd share the Bruins love.

Bad blogger!

So....obviously I'm back in Philadelphia  (2.5 weeks deep into cardiology no less). Clearly I got too distracted by the lions and pizza to update the blog. My bad.

I'm going to post a few things that I'd been meaning to finish and then I will write a post that sort of concludes my experience.

As a peace offering for my derelict behavior: I've included a picture of me petting a cheetah!